Collection of the BD SurePath Pap Test with a broom device plus endocervical brush improves disease detection when compared to the broom device alone or the spatula plus endocervical brush combination

Abstract

Objective:Here we examine the diagnostic utility of the US Food And Drug Administration (FDA) approved Spatula + endocervical brush combination for the BD SurePath Pap Test (SPPT) and compare it to SPPT collection with the broom alone or to an off-label combination of broom + EC brush. This question is important due to lingering concerns over the value of EC detection to a satisfactory Pap test.Methods:20,125 SPPT vials were examined for the collection devices contained. The SPPT collection device combinations allowed were: Rovers Cervex-Brush (broom, FDA approved), Medscand Pap Perfect Spatula + Medscand CytoBrush Plus GT (spatula + GT brush, FDA approved) or Rovers Cervex-Brush + Surgipath C-E Brush (broom + CE brush, off label).Results:Examination of SPPT vials revealed 11,130 collected with the broom, 4,687 collected with the spatula + GT brush and 2,921 collected with the broom + CE brush. Absence of an endocervical/transformation zone was seen in 22.86% of broom cases, 13.10% of spatula + GT brush cases (p= 0.00005 vs broom) and 10.17% of broom + CE brush cases (p= 0.00005 vs broom, p= 0.00005 vs spatula + GT brush). Importantly, LSIL detection was: broom 2.99%; spatula + GT brush 2.45% (p= 0.053 vs broom); broom + CE brush 4.18% (p= 0.034 vs broom, p= 0.0001 vs spatula + GT brush).Conclusion:When broom + brush combination is compared to broom alone or to spatula + GT brush, the broom + CE brush combination better sampled the endocervical/transformation zone and increased LSIL detection.

Transformation zone sampling rate used as a performance indicator for cervical liquid‐based cytology sample‐takers

“…It is interesting to note that in our study 66% (115/175) of qualifying practitioners have a TZSR below 80%. Other previous studies reporting on the endocervical/metaplastic cell component of LBC samples found it to be present in 70.6%, 76% and 77.14% of samples. These findings and the average TZSR of 70% from this study suggest that the greater than 80% target is not suitable for LBC samples.…”

Broom versus broom-and-brush: A comparison of Surepath® liquid-based Papanicolaou test (LBPT) collection devices

“…[1] had a higher calculated abnormal rate (10.5% vs. 7.4% in our study), largely due their higher rates of ASC-US (6.4% vs. 4.3%) and LSIL (3.1% vs. 2%), while their HSIL rate was lower (0.23% vs. 0.31%).…”

“…[1] do not provide age data for their population, however, based on the higher rate of both ASC-US and LSIL we suspect that their study population may be younger than ours.…”

“…We wish to report our findings from a similar study we conducted as they are somewhat different from those of Davis-Devine et al [1] and may be of interest to the readers of Cytojournal . Preliminary findings from our study were presented at the United States and Canadian Academy of Pathology 2008 Annual Meeting.…”

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty

“…Whereas the majority of Doctors favoured colposcopy follow-up and this attitude may be influenced by the higher proportion of women with cervical cancer they manage. Although current evidence suggests an increased cytological yield when using a cytobrush in combination with a Cervex-Brush (which samples cells from inside and outside of the cervix) [ 40 ], there is a paucity of evidence correlating this increased yield of cells when used in conjunction with unsatisfactory colposcopy [ 41 ]. This lack of knowledge and the inability of community services to offer a cytobrush compounded decision-making, particularly for doctors.…”